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Localised prostate cancer: treatment according to the risk of progression

Treatment of localised prostate cancer depends on its progression. Patients should be involved in the decision and well informed of the benefits and harms of the different options.

Localised prostate cancer mainly affects men over the age of 65 and does not progress beyond the prostate. The risk of progression varies depending on the size of the tumour, the cell type and the PSA level. Patients should be involved in the decision and well informed of the benefits and risks of the different treatment options.

When there is a low risk of the cancer progressing, the mortality rate for prostate cancer is lower than 0.5% a year. In patients whose life expectancy is less than 10 years, it is better for them not to be exposed to the adverse effects of a treatment from which they will gain little or no benefit. When life expectancy is over 10 years, monitoring with no initial treatment is one option. The risk of death within the coming 10 years is around 5%. Prostatectomy (total removal of the prostate) prevents death from prostate cancer in around 1 in 10 patients who have the operation, but exposes around 1 to 2 patients out of 10 to urinary incontinence. 75% of patients operated on experience erectile dysfunction, as opposed to 50% who opt for monitoring. External radiation therapy is perhaps less effective in reducing the mortality rate. There are fewer cases of erectile disorder and urinary incontinence, but it sometimes results in severe urinary and anal disorders, and even secondary cancers. It is not certain that the implantation of a radioactive product in the prostate (brachytherapy) is as effective, but it exposes patients to a lower risk of erectile disorders and urinary incontinence.

In patients where the risk of the cancer progressing is high, the mortality rate from prostate cancer is around 4% a year. Treatment is generally necessary, especially total prostatectomy. External radiation therapy combined with hormone therapy for 6 months is another option.

©Prescrire 1 October 2012

"Management of localised prostate cancer. Watchful waiting, surgery or radiation therapy, depending on the natural course, which is often relatively slow" Prescrire Int 2012; 21 (131): 242-248. (Pdf, subscribers only).
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See also:

Localised prostate cancer:
inform patients of the long-term
effects of various treatments
(March 2011)
Free

Knowing a disease's
natural history helps
make decisions
(June 2008)
Free